INCREASING OPIATE ABSTINENCE THROUGH VOUCHER-BASED REINFORCEMENT THERAPY

Heroin dependence remains a serious and costly public health problem, even in patients receiving methadone maintenance treatment. This study used a within-subject reversal design to assess the effectiveness of voucher-based abstinence reinforcement in reducing opiate use in patie nts receiving methadone maintenance treatment in an inner-city program . Throughout the study subjects received standard methadone maintenanc e treatment involving methadone, counseling, and urine monitoring (thr ee times per week). Thirteen patients who continued to use opiates reg ularly during a 5-week baseline period were exposed to a 12-week progr am in which they received a voucher for each opiate-free urine sample provided; the vouchers had monetary values that increased as the numbe r of consecutive opiate-free urines increased. Subjects continued rece iving standard methadone maintenance for 8 weeks after discontinuation of the voucher program (return-to-baseline). Tukey's posthoc contrast s showed that the percentage of urine specimens that were positive for opiates decreased significantly when the voucher program was institut ed (P less than or equal to 0.01) and then increased significantly whe n the voucher program was discontinued during the return-to-baseline c ondition (P less than or equal to 0.01). Rates of opiate positive urin es in the return-to-baseline condition remained significantly below th e rates observed in the initial baseline period (P less than or equal to 0.01). Overall, the study shows that voucher-based reinforcement co ntingencies can decrease opiate use in heroin dependent patients recei ving methadone maintenance treatment.